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Disclosure of Material Interest

Disclose a material interest in a contract by a director, officer or shareholder of a corporation with this free Disclosure of Material Interest form.


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DISCLOSURE OF MATERIAL INTEREST - SPECIFIC TRANSACTION

TO: ________________________________ (the /Corporation/)

AND TO: THE DIRECTORS THEREOF

Whereas _________________________________________ (set out the details of the transaction);

I hereby disclose that I am a shareholder, director and officer of __________________________, and have a material interest in ____________________________ and the Corporation.

DATED effective the ___ day of ___________, 20____.


_________________________________________________________________
(signature)



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SKU: 190

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